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The Managed Care Insider eNews
Volume 5, Number 1
February 2003
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The Insider is back. This issue deals with hope and the future. While most businesses
are struggling with economic issues, and countries are talking of war, one man
has decided to forge ahead with a new future and new hope. As always, we appreciate
your comments; please send them to insider@scheur.com
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New Chapter, New Verse, New Meaning
By Barry Scheur
There hasn't been a column for a while. This newsletter which was so regular
for several years, has become somewhat irregularly timed and unpredictable, a
mirror of the turbulent days of transition surrounding the conclusion of the
saga of the Oath. But, in reality, this isn't very unusual - many people right
now are facing fundamental challenges in the wake of our "economic turndown" euphemism
which translates into insecurity about job, money, and the future. Well, I have
walked in those shoes for ten months now, perhaps an appropriate period of mourning
or indecision.
In November, we sold The Oath for Alabama to NewQuest, an H M O management company
that believes in Medicare risk. All I can say is that at the very end, the deal
changed markedly. I wanted to be out of the business and settle up with the banks
in Louisiana to personally pay those obligations that existed from that state.
My bargaining power was not good, my leverage was worse, and the new owner's
attitude in the final days was, in my opinion, symbolic of most venture capital
deals at their most difficult. But that's deal making at center stage. Perhaps,
that's what's wrong with the business/healthcare industries who are facing financial
challenges in general.
But enough of that, because what I want to convey to those of you who find this
column interesting and provocative, is a spirit of hope, even in the face of
the most difficult obstacles.
Previously, I wrote a little about developing a technology for the visually handicapped
that has never existed. Most of you know by now that I am blind and have had
to face challenges you take for granted.
I cannot see money denominations and have to clip like denominations together
to keep from giving cab drivers larger tips! I can speak on a cell phone, but
unlike you, I cannot use the menus nor can I see who is calling on Caller ID. "Windows" do
not open the world to me on computers; they make life much more difficult. Reading
a newspaper? I have to go online and find a text only site on the web or use
a newspaper dial-in phone service that reads stories synthetically. That's not
very good access. Get prescriptions filled? You can read the labels, blind/visually
impaired people cannot. Packing to travel? I, with the help of my wife, have
segregated clothing by style and color to be able to hopefully look "put
together" when seen by others. The things you take for granted as a sighted
person, are challenges we face on a daily basis. I'm not complaining, I'm grateful
that I've been able to learn the skills and develop the inner toughness that
causes me not to think about this stuff very much, and if I do, it's usually
with humor.
When I was in New Orleans, I did some work with the Lighthouse for the Blind.
We were trying to raise awareness and money for their excellent programs, and
I chaired a very successful annual "Blind Awareness" campaign. My friends
at Trumpet Advertising did a pro bono spot to cause people to rethink the stereotypes
they had about blind people. It was both brilliant and controversial. They had
me drive a car (raised on a special platform that was actually being towed) while
I talked about people's perceptions as to what blind people could do. I had a
ball turning the wheel, gunning the motor and pretending I was actually driving,
something I will never be able to do. We did such a good job that one of the
local newspaper reporters actually called our communications person and asked
how we could put people in New Orleans in jeopardy by allowing a blind person
to drive!! (But that may speak to the level of competence of some of the New
Orleans news reporters.)
Here are some things you may not know! Only about one in every thousand pieces
of information that you read daily (books and magazines) gets made available
in any readable format for the blind, that is, audio books or Braille. Often,
the material shows up six months late. Time, People, TV Guide, not to mention
all of the special interest magazines, don't exist. Want to find a book about
traveling somewhere in Braille or on cassette? Forget it! More astounding yet,
the books that are produced for the blind in limited quantity by the National
Library Service of the Library of Congress cannot be bought, only loaned. Our
book and magazine accessibility for visually impaired people ranks way behind
other countries such as England, Canada, or Australia in a number of respects.
We've all heard that knowledge is power, and with reading you get information
and knowledge. The right to read exists everywhere in this country, except for
those with a major visual disability.
Sometime ago, I was exposed to an opportunity to acquire a company or license
its technology to produce an Internet appliance that would download and read
books stored digitally to blind people. It also would provide access to a variety
of information and services that people who can see take for granted.
Well, in my usual fashion of jumping ahead of myself, I spent a good deal of
the little personal capital I have left, evaluating the marketplace for this
product, which took me all over the U. S. and Europe. As an avid technologist
and gadget seeker, especially when it comes to stuff for blind people, I have
spent the last twenty years in beta testing, idea swapping, and even tried to
enter this business by offering to buy a technology company that made computers
for the blind in the early 1990s. Almost one hundred thousand dollars later,
the company in California whose set-top box technology I was interested in walked
away from a deal because they wanted big bucks, and frankly, I couldn't give
them the kind of exorbitant money they wanted. So for the past few months,
I've reflected and considered what do I really want from life and what do I want
to give to it?
I was about ready to give up on this technology. I couldn't quite re-create it
and I didn't want to lose the eighteen months to build the hardware and software
that I thought I had agreed upon to purchase.
Then, just as in 1983, some twenty years before when I first became a health
care consultant, it hit me.
I have often said that the simplest maxim for defining one's career is an old
country and western song title - Do What You Do Do Well. What I do well is build
talented teams of people, many of whom have been overlooked for certain opportunities
because of a variety of reasons. In 1973, right after I graduated college, I
sat with the President of Dell Publishing, a family friend, and literally pleaded
with her to go into the audio book business so that people could listen to books
during their commute. They didn't do that for fifteen years, and are the poorer
for it.
I like excitement and love bringing together people, and I understand blindness
and technology as a user and an advocate. What I do well and what I love to
do involves relationships. I have invested large sums over the years based on
how I felt about the capabilities and integrity of people, without exhaustive
research, because instinctively, decisions are as much about numbers as about
beliefs and feelings of the heart. Sometime I have lost, sometimes I have won.
Many people I know are more prudent, but often, they win less and never get to
experience the passion of a struggle that is bigger than yourself.
So, along with some health care consulting, in order to keep paying a couple
of key employees as well as the rent and light, (I've haven't taken a full-time
salary for myself in almost a year) here's what I'm going to do:
I intend to find a way, working with the best and brightest minds, blind and
sighted, that I have already assembled, to change what it means to have a visual
impairment when it comes to quality of life. Pure and simple. Why is this important?
Bear with me and consider the following:
- Over seventy percent of blind people in this country are unemployed, and probably
another twenty percent are underemployed.
- Unfortunately, most blind peoples' lives revolve around relationships with
other blind people - not that this is bad, but it's isolating. The lack of sight
should not become a preoccupation, it is a characteristic that needs to be dealt
with and overcome.
- Only twenty percent of the 7.5 million visually impaired people in this country
are online, as compared to a percentage three to four times that for sighted
people.
- What blind people do online is severely challenged by the combination of inaccessible
products and inaccessible web sites.
- Braille, the language of blind people, is being taught less and less in the
schools. Why? Because the teachers aren't trained in it and the restrictive
and ever-tightening school budgets won't permit it. Fact: the equivalent of
a Palm Pilot in Braille costs, are you ready for this, seven thousand dollars.
That same type of machine which utilizes speech output technology to read the
screen back to you costs over two thousand dollars. Making a computer talk and
carry out functions like being able to scan in printed material so blind people
can read it carries with it a price tag of $1,300 for good quality software.
Do you know of any software that a sighted person would buy for any application
that would cost that much?
As the visual reliance on icons, visual displays and jog dials increases, blind
people can use less and less of what's out there to be bought. Try closing your
eyes and scanning the hundreds of TV channels you now have access to without
a menu.
In many countries, currency denominations are marked for blind people by the
government. In the United States and in response to a threatened lawsuit, the
U. S. Treasury disbanded an advisory committee that had even started considering
the issue. Perhaps saddest of all, the money that it takes to develop and innovate
ideas and build new technologies isn't available because the return on investment
for creating the business motive just isn't there very often.
Venture capital and disability don't often mix very well. The companies that
do make blindness technology are mostly underfunded and build devices which become
obsolete almost before they are introduced.
For years, I have pondered what to do about this in my usual out-of the-box way.
Two years ago, I organized a worldwide congress hosted by the National Braille
Press on the future of Braille technology. The thinking was large, but the organization's
ability to put the kind of money together that is needed to create this core
technology, driven by the real needs of consumers and which is also cheap is
way beyond the vision (no pun intended) or means of this group.
So I started thinking: "Why not get a group of dotcom entrepreneurs together
and ask them for help, or rather, to give back a little of what the free market
gave to them?" That was before the crash, and I had made some progress,
but like the sands, that is an ever-changing and shifting landscape.
Please also understand another anomaly - in the past thirty years of my life
devoted to my legal education and legal and business career, I've only had the
opportunity to interact with about five blind people. Why? Because blindness
hasn't been the centerpiece of how I built my existence. Yes, I have strived
mightily to eliminate the economic handicaps that blindness imposes in terms
of transportation, access to recreational activities (ski guides who are accomplished
at leading blind skiers are not easily available and if you want them when you
want them you must pay dearly for them) access to information, shared experiences
with sighted kids who don't quite understand why their Dad doesn't drive or hit
baseballs, etc.
As much as I have become a fixture or a fossil (quoting someone else's description)
in the managed care industry, over these past twenty-five years, I have discovered
that this doesn't mean very much when it comes to rebuilding a career sidetracked
into a misguided venture of trying to cure a managed care industry that I'm afraid
is terminal but which hasn't gotten the news from its doctors quite yet.
So, what is all of this leading up to? Quite simply this! I am going to use every
bit of intelligence, persuasion, technical knowledge, team building, and creative
energy at my command to create an enterprise zone that can evaluate and invest
in technologies that will help the lives of blind people and which can also be
made affordably and profitably. I'm going to build a Talking Media Center as
a flagship product that will allow people who struggle reading print because
of visual loss or age to listen to downloaded materials from the Internet, whether
it is a current bestseller or daily newspaper. I am going to scour the world
for ideas and as yet un-commercialized technology that can be developed and brought
to production. And I'm going to do it with a core group of blind engineers, programmers,
and service people who understand that if we don't make a difference now, we
won't have an opportunity in the future.
Next week, I am heading off to Japan, Korea, Hong Kong, and China for twenty-two
days of meetings. These encounters are mostly with companies that have developed
technological applications for blind people in the Far East that haven't been
brought to the U. S. because of the challenge of culture, not to mention the
challenge of establishing trusting relationships with U. S. business people.
And then, there's still the issue of money.
What am I going to try to do beside produce this box that will read books, play
Internet radio streams on demand, perhaps allow a blind person to easily tune
and program a TV and or DVD for the first time? I'm going to try to find cheaper
sources of supply and new technologies to reduce the $7,000 cost of that Braille
Palm Pilot equivalent. I'm going to find a way to reduce the cost of the software
that makes computers talk to a price that an individual can readily afford. I'm
going to look into making several cell phones of commercial manufacturers speech
accessible and then request the U. S. territory as distribution. I may even try
to negotiate with Sony to help me build a much cheaper talking computer than
ones you can currently buy and assemble from the blindness technology companies.
And most importantly, I'm going to assemble a group of people who recognize that
we're about to be engaged in a calling. Unlike just about everything else in
the world, this isn't going to get done without somebody deciding to put themselves
to the wheel and take a risk.
It's going to take about $2 million to shape the basics of this vision. I'll
be into the company for probably well over half a million before I'm very much
farther along. This column is not a solicitation, and it wasn't written for that
purpose, there are people who have stepped up to the plate to help.
But if you are interested in investing in something that could both change the
definition of what it means to suffer from vision loss and do something meaningful
that otherwise won't be done in our lifetime, then let me know. I'm willing to
pay interest on the money, as well as giving people a piece of the business under
development. Some of the commercialization opportunities, for example, commercializing
a newspaper service that provides over 100 newspapers to blind people and introducing
a commercial subscription service to be delivered digitally to portable players
and cars have great profitability potential.
I will write another column after my return from the Far East, to keep you
updated on this project as well as update you on health care trends. I am speaking
at the National Managed Health Care Congress in March in D.C. on "turnarounds" what
works, what doesn't. I guess you could say, I have become an expert on the "what
doesn't". So please stay tuned, as you have stayed with me since the inception
of this ezine. It may not be solely an insider to managed care, but it is an
inside to the depth of issues surrounding people, whether its healthcare, business
success or failure, or taking the issue of helping a significant population finally
have a level playing field in life.
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End of The Managed Care Insider eNews,
Volume 5, Number 1.
Scheur & Associates (S&A) is one of the most experienced specialized
healthcare operations management and business revitalization consulting firms
in the country. Our expertise is in time-sensitive analyses, strategic business
and market planning, operational re-engineering, and communications, as well
as implementation of start-ups, expansions, and new products. The firm's clients
cover the spectrum of insurers, managed care organizations, physician groups,
integrated delivery systems, hospitals, employers, governmental entities, vendors,
and other providers.
Contributing to this edition is Barry S. Scheur. Editing and Research by Nancy
Belle.
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